Extensive Surgery for Thyroid Cancer: Central Neck Dissection

Cervical lymph node metastasis in thyroid cancer is common and mostly located in the central neck compartment or the lateral neck. Lymph node metastases are known to significantly increase both the persistence and recurrence rate of the disease, possibly decreasing survival. Cervical ultrasound is often the initial imaging modality employed to provide an anatomical roadmap for surgical planning. Therapeutic central neck dissection is recommended for all patients with pathological lymph node involvement noted on preoperative clinical or imaging assessment. Prophylactic central neck dissection in patients without detectable lymph node involvement remains a controversial topic due to a lack of definitive evidence of improved recurrence rates or survival and the possibility of higher complications. Reoperative central neck dissection for persistent/recurrent disease demands careful weighing of the risks and benefits to the patient due to the challenging nature of this procedure and increased risk of complications.